Program cuts cavities in low-income toddlers

NEW YORK (Reuters Health) - Preventive dental care from pediatricians and family doctors may help reduce the widespread problem of early childhood cavities in low-income kids, a new study finds.

In the U.S., it's estimated that up to 11 percent of 2-year-olds and 44 percent of 5-year-olds have cavities. And the majority of those children are from low-income families.

The new study, published in the journal Pediatrics, looked at the effects of a North Carolina program dubbed "Into the Mouths of Babes." Since 2000, pediatricians and family doctors in the program have been giving fluoride treatments and dental exams to babies and toddlers covered by Medicaid -- the government health insurance program for low-income Americans.

Between the ages of 6 months and 3 years, children could have up to six doctor visits with dental services. Their doctors would apply fluoride "varnish" to their teeth and also look for any problems that needed care from a dentist.

Researchers estimate that between 2000 and 2006, children in the state's Medicaid program who had at least four visits were 17 percent less likely than those with no visits to have cavities by the age of 6.

"This speaks to the fact that prevention does work," said Dr. Mary J. Hayes, a pediatric dentist in Chicago and spokeswoman for the American Dental Association.

In the past, Hayes told Reuters Health, people thought children did not need professional care of their teeth until about the age of 3. But tooth decay can begin in infancy; and decay in "baby" teeth raises children's risk of the same problems in their permanent teeth.

"Now we know that prevention needs to begin when the first teeth come in," Hayes said.

In general, it's recommended that all children see a dentist by their first birthday. But in reality, few general dentists are trained to treat very young children, and a pediatric dentist, Hayes noted, can be hard to find -- particularly for people on Medicaid.

In North Carolina, for example, only about one-quarter of all dentists accept Medicaid.

Since pediatricians and family doctors see infants and young children regularly, she noted, "we should involve the medical community. It makes sense that pediatricians be trained to look at the teeth."

For the study, Dr. Bhavna T. Pahel and colleagues at the University of North Carolina, Chapel Hill, looked at data on nearly 322,500 children enrolled in the state's Medicaid program between 2000 and 2006. Of those children, 13,424 had at least four visits to their doctor for preventive dental care, while almost 195,000 had no visits.

The researchers found that the effectiveness of the program varied with children's age. They estimate that children who had their initial visits between 12 and 15 months of age were half as likely to need any cavity treatment by the age of 17 months, versus children with no visits.

The program also cut back on cavities in kids older than three-and-a-half.

The program didn't reduce the number of treatments for cavities between the ages of two and three-and-a-half, however. The researchers speculate that some of the children in that age group might already have had tooth decay when they came for their first fluoride treatment.

The study did not look at whether the program ultimately saves money. Medicaid pays about $55 for each preventive visit.

Cost-effectiveness is a question for future studies, Pahel's team writes.

Hayes agreed that future studies need to look at costs; her home state of Illinois has started a similar Medicaid program, and a majority of U.S. states have made changes in Medicaid to reimburse doctors for preventive dental care in young children.

Hayes said that parents can also take steps to prevent early tooth decay.

"Get your child used to having a toothbrush right away," she suggested. When teeth are first emerging, parents can use a soft brush made for babies, along with water, to gently brush along the teeth and gums.

According to Hayes, parents should always brush young children's teeth for them, since they lack the motor skills to do it properly. "Start early and make it a routine," she said, "so it's not an option."